Question 1

What is ICD-10 code H01.111?

Accepted Answer

H01.111 is the ICD-10-CM diagnosis code for allergic dermatitis of right upper eyelid. An allergic skin reaction affecting the upper eyelid of the right eye, causing inflammation and irritation. H01.111 sits in the ICD-10-CM chapter for diseases of the eye and adnexa (h00-h59), within the section covering disorders of eyelid, lacrimal system and orbit (h00-h05).

H01.111 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Verify that the condition is allergic in nature and not infectious or due to other causes.

Question 2

Is H01.111 an HCC code?

Accepted Answer

No. H01.111 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is H01.111 billable?

Accepted Answer

Yes. H01.111 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. H01.111 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for H01.111?

Accepted Answer

H01.111 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards H01.111 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 5

What should coders know when reporting H01.111?

Accepted Answer

Verify that the condition is allergic in nature and not infectious or due to other causes Confirm right eye and upper eyelid location in the documentation before coding

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H01.111

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H01.111 ICD-10-CM Code: Allergic dermatitis of right upper eyelid

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H01.111

Is H01.111 an HCC code?

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What This Code Means

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